Deep brain stimulation (DBS) is a procedure as mysterious as its name. The delicate surgery requires drilling through a patient’s skull and inserting a slender electrode, or “lead,” into the brain along with an extension wire connected to a neurostimulator (a battery source implanted near the collarbone that sends electrical signals to the lead). The effect of DBS is to block malfunctioning circuits in the brain, though exactly how that happens remains unknown. What we do know is that, for thousands of patients with Parkinson’s disease, epilepsy, dystonia, tremor, and other neurological disorders, the procedure has been life changing.
Few people have witnessed the effects of DBS more intimately than Kathryn L. Holloway, a professor at Virginia Commonwealth University School of Medicine and chief of neurosurgery at the Hunter Holmes McGuire V.A. Medical Center in Richmond. Holloway CCAS’80 has performed hundreds of the procedures but still thrills at their effect on patients. “I can make a big difference in someone’s life on pretty much a daily basis,” she says, “and that’s really rewarding.”
The daughter of a builder, Holloway had an inclination for tinkering that drew her to medicine. She expected to follow two of her siblings into nursing—largely because she didn’t think she could afford medical school—but a chemistry instructor at the Camden College of Arts and Sciences assured her that if she got into medical school, financial aid would be forthcoming. “I credit her with making me a neurosurgeon,” Holloway says.
Her pioneering work has quite literally changed the face of DBS. Until recently, the procedure required that the patient wear a stereotactic frame—a bulky metal “halo” bolted to the skull that impairs vision and motion and is secured to the surgical table—for the length of the operation, which can take up to eight hours. Given that patients are awake for a large portion of that time, the frame, which Holloway likens to “a medieval torture device,” led to claustrophobia and significant discomfort. So Holloway, working with a group of like-minded professionals, devised a method of performing DBS without the frame, using instead five small bone screws and a palm-sized disposable guidance device. “The greatest advantage for patients,” she says, “is that they don’t know or care about the screws because they can’t see them.”
She envisions a day when DBS will be widely used for a broad spectrum of maladies, including tinnitus, obesity, anorexia, addiction, and schizophrenia. She is currently involved in research on applying DBS to treat recalcitrant depression. Speaking like a true tinkerer, she says, “These are all diseases in which you don’t see anything wrong with the brain, but the circuits are functioning poorly. You just have to figure out the circuits, and then you can fix the problem.”
(This story is excerpted from “5 Star Alumni” in the Spring 2012 issue of Rutgers Magazine.)
